Supplements Play a Role in 2010 New Dietary Guidelines for Americans

Supplementation and fortified foods can help Americans improve their nutrient intake, according to USDA and the Department of Health and Human Services (HHS), which today announced their new 2010 Dietary Guidelines for Americans.

“In certain cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise might be consumed in less-than-recommended amounts,” the guidelines state. “Dietary supplements or fortification of certain foods may be advantageous in specific situations to increase intake of a specific vitamin or mineral. In some cases, fortification can provide a food-based means for increasing intake of particular nutrients or providing nutrients in highly bioavailable forms.”

The guidelines also recognize the role dietary supplements can play in maintaining health against disease. “Supplements containing combinations of certain nutrients may be beneficial in reducing the risks of some chronic diseases when used by specific populations. For example, calcium and vitamin D supplements may be useful in postmenopausal women who have low levels of these nutrients in their diets, to reduce risk of osteoporosis.”

Naming Nutrients
Specifically, the guidelines mention four nutrients as examples in which supplementation may be advantageous: vitamin D, folic acid, vitamin B12, and iron supplements for pregnant women.

For vitamin D, the guidelines mention that vitamin D-fortified milk is now the major source of vitamin D for many Americans. Other sources include fortified foods such as orange juice, soy beverages, and yogurt, as well as vitamin D supplements.

For folic acid, “Most recently, folic acid fortification of enriched grains was mandated to reduce the incidence of neural tube defects, which are serious birth defects of the brain and spine. Subsequently, folate intake has increased substantially.” The report recommends that women “capable” of becoming pregnant consume 400 mcg/day of folic acid “from these fortified foods or from dietary supplements, in addition to eating food sources of folate.”

For individuals over the age of 50, as well as vegans, the guidelines encourage foods such as fortified cereals or supplements that provide the crystalline form of vitamin B12, which the guidelines call a bioavailable form.

Finally, the guidelines recommend iron supplements for pregnant women.

On a broader scale, the guidelines also address nutrients such as omega-3 by recommending that Americans increase their intake of fatty fish.

However, the report was neutral on supplements such as multivitamins, specifically stating that “sufficient evidence is not available to support a recommendation for or against the use of multivitamin/mineral supplements in the primary prevention of chronic disease for the healthy American population.”

The guidelines also take care to warn Americans against consuming exceedingly high nutrient levels. “High levels of certain nutrient supplements may be harmful, if a nutrient’s Tolerable Upper Intake Level (UI) is exceeded. Supplement use may be discussed with a healthcare provider to establish need and correct dosage.” As an example, the report warns consumers that “potential risk of adverse effects increases” for vitamin D intake above 4000 IU (100 mcg)/day, the upper intake level established in November by the Institute of Medicine in its new dietary reference intake recommendations for vitamin D.

Despite "Food First," Supplements Play a Role
To a large extent, the guidelines focus on a “food first” approach: “A fundamental premise of the Dietary Guidelines is that nutrients should come primarily from foods. Foods in nutrient-dense, mostly intact forms contain not only the essential vitamins and minerals that are often contained in nutrient supplements, but also dietary fiber and other naturally occurring substances that may have positive health effects.”

On the whole, however, the message is positive for industry, says Douglas MacKay, ND, vice president of scientific and regulatory affairs for the Council for Responsible Nutrition (CRN; Washington, DC).

“I think we all know that the dietary guidelines really try to emphasize ‘food first.' This is really intended to tell Americans what to eat to be healthy, and they’re concerned about the concept that people consume supplements instead of healthy food.”

He continues, “There’s a little bit of resistance based in that area, but I think as time goes on, we’re seeing progress, and we’re seeing that, specifically in the areas of nutrients of concern, they recognize that fortified-food and dietary supplements can play an important role, as an option. For instance, they mention dietary fiber, calcium, folic acid, vitamin B12, and vitamin D specifically for some sub-groups.”

“I think the progress is in their recognition that dietary supplements can play an important role in filling nutrition gaps,” he says.

Supplements: Filling Nutrient Gaps
MacKay also points out that supplements are useful considering that realistically, people may not be able to meet all of their nutrient needs with foods, especially when trying to reduce calorie intake.

“I think that when nutritional educators and other downstream-users of the dietary guidelines try to apply the principles set forth, in a real-world scenario, especially considering the framework of not consuming too many calories, they’ll start to look at the food sources of nutrients like fiber and vitamin D and think about how we can increase our intake of these nutrients, without bumping above our calorie ceiling. They’re going to realize that to make sure people have an optimal, nutrient-dense diet with these calorie ceilings, it’s going to make sense to add a calcium or an omega-3 supplement. I think that overall, in the context of obesity and not consuming too many calories, nutrient-dense, no-calorie multivitamins have a very strong place.”

Limited access to proper nutrients may also call for supplementation. MacKay points out that for omega-3, when costs and access to cold-water fatty fish high in omega-3 might be formidable for some, omega-3 supplements may be an option. Similarly, for a nutrient like fiber for which people are currently only consuming about half of the recommended intake, supplementation can help, as can multivitamins, especially when “they recognize that 15% of American households have been unable to acquire adequate food to meet their needs. To me, that speaks for the possible need for multivitamins to be included in [programs] such as WIC [for low-income individuals] and food stamps.”

“So without the dietary guidelines themselves in the text promoting supplements, I think the framework that we’re looking at in the recommendations for increasing certain nutrients is really going to be supportive of the role of supplements in helping people live healthy lives,” he says.

New Emphasis: Obesity
The updated version of the guidelines focuses heavily on the obesity epidemic facing the country.

“The 2010 Dietary Guidelines are being released at a time when the majority of adults and one in three children is overweight or obese, and this is a crisis that we can no longer ignore,” said Thomas J. Vilsack, USDA’s Secretary of Agriculture, at today’s press conference. “The bottom line is that most Americans need to trim our waistlines to reduce the risk of developing diet-related chronic disease” such as cardiovascular disease, diabetes, and metabolic syndrome.

As such, the guidelines place stronger emphasis on reducing calorie intake and increasing physical activity, and eating healthier foods such as vegetables, fruits, whole grains, fat-free and low-fat dairy products, and seafood.

In terms of reductions, the guidelines emphasize consuming less sodium, saturated and trans fats, added sugars, and refined grains. (Specifically, the guidelines recommend minimally reducing daily sodium intake to less than 2300 mg. Going further, the guidelines suggest a reduced intake of 1500 mg, a recommendation that applies to people 51 years of age and older and half of the U.S. population, including children and the majority of adults.)

USDA and HHS also announced they would be releasing a “next generation” Food Pyramid in the coming months.

Overall, the guidelines focus on wellness and “a system that will be focused on wellness and prevention, and not just sick care,” said Vilsack.

The Dietary Guidelines for Americans are reviewed and updated very five years, based on evolving health science.